American cardiologists have updated medical recommendations for cholesterol control and cardiovascular disease prevention, urging earlier testing for children and earlier medical treatment for patients at risk of heart attack and stroke.
The new guidelines, reported by ScienceAlert, replace the previous standards published in 2018. While maintaining a strong focus on cholesterol management, the updated advice places greater emphasis on early prevention and prompt medical intervention when lipid metabolism disorders are detected.
Cardiologist Roger Blumenthal from Johns Hopkins University said most cardiovascular diseases are potentially preventable, identifying elevated low-density lipoprotein, or bad cholesterol, as a primary risk factor. Blumenthal noted that lifestyle modifications should remain the initial step, but doctors may now prescribe lipid-lowering drugs earlier if patient cholesterol levels fail to improve after a period of dietary and exercise changes.
Specialists emphasized that the longer an individual maintains low levels of bad cholesterol, the greater their long-term protection against future heart attacks and strokes. Low-density lipoprotein cholesterol is a fatty substance that can accumulate along arterial walls, restricting blood flow and causing plaque buildup that leads to cardiovascular complications. Johns Hopkins University, located in Baltimore, Maryland, is one of the leading medical research institutions in the United States.
Cholesterol Screening for Children and Adults
A major shift in the updated guidelines involves the recommended age for initial cholesterol screening. Under the new recommendations, children should have their cholesterol tested for the first time between the ages of 9 and 11 if they have not previously received the blood test. For children with a family history of severe cardiovascular disease or cholesterol disorders, doctors recommend starting screenings much earlier, from 2 years of age.
For adults aged 30 to 79, specialists recommended adopting the new PREVENT risk calculator. The tool enables physicians to evaluate a patient risk of developing cardiovascular disease over both 10-year and 30-year horizons. The calculator incorporates blood cholesterol levels, blood pressure measurements, age, and individual health metrics, while additional risk factors help doctors determine whether a patient requires lipid-lowering therapy.
Target Cholesterol Levels and Medications
The guidelines establish updated target values for bad cholesterol when selecting medical treatments. For patients categorized at borderline or intermediate risk, the target is less than 100 mg/dL. For individuals at high risk, the target drops to less than 70 mg/dL, while patients with atherosclerotic cardiovascular disease who are at very high risk must aim for less than 55 mg/dL.
Doctors may consider LDL-lowering therapy for patients with a 10-year atherosclerotic cardiovascular disease risk of 3 to 5 percent, representing borderline risk. For intermediate risk levels between 5 and 10 percent, doctors should consider lipid-lowering therapy more actively. Cardiologist Pamela B. Morris from the Medical University of South Carolina noted that lower levels of bad cholesterol generally offer better protection for individuals facing an elevated risk of heart attack or stroke. The Medical University of South Carolina, based in Charleston, is a major academic health center known for cardiovascular research.
Statins remain the primary medication prescribed to lower bad cholesterol levels. When statins alone are insufficient, physicians may also prescribe ezetimibe, bempedoic acid, PCSK9 inhibitors, or inclisiran. Statins function by blocking an enzyme in the liver required for cholesterol production, whereas newer therapies like PCSK9 inhibitors and inclisiran target specific proteins or gene pathways to accelerate cholesterol clearance from the bloodstream.
Despite the expanded role of early medication, specialists stressed that healthy living remains the core foundation of prevention, requiring a nutritious diet, regular physical activity, and routine health checkups. In related health guidance, experts previously noted that cheese can form part of a daily healthy diet if consumed in moderation. While excessive cheese consumption can elevate cardiovascular risks due to saturated fat content, moderate portions provide nutritional benefits without compromising heart health.
